Summary & Overview
HCPCS G9582: Door-to-Puncture Time >90 Minutes, No Reason Given
HCPCS Level II code G9582 documents a door-to-puncture interval greater than 90 minutes with no reason given for delay in initiating an endovascular puncture procedure, typically applied in acute stroke care. This measure matters nationally because timely reperfusion is a critical quality and outcome determinant in ischemic stroke management; coding for prolonged door-to-puncture intervals without documented justification highlights potential gaps in workflow, capacity, or documentation that affect clinical outcomes and quality reporting.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code's clinical context, the typical site of service (acute hospital settings such as emergency departments and interventional suites), and what to expect from payer coverage considerations and quality measurement use. The publication frames where this code fits within stroke care performance measurement and hospital reporting, notes common modifiers when available, and outlines the types of benchmarks and policy implications that are typically relevant for national analyses of timeliness measures.
This summary is intended to orient clinicians, administrators, and billing professionals to the purpose and implications of G9582, and to point toward areas—workflow, documentation, and reporting—where this code commonly signals attention is needed. Data not available in the input for specific payer policies, associated taxonomies, ICD-10 mappings, and related codes.
Billing Code Overview
HCPCS Level II code G9582 indicates a door-to-puncture time of greater than 90 minutes with no reason given. The service type is stroke-related vascular intervention timing measurement, reflecting an instance where the interval from patient arrival to arterial puncture exceeds 90 minutes without documented justification. The typical site of service for this code is an acute hospital setting, specifically locations where endovascular thrombectomy or other puncture-based cerebrovascular procedures are performed, such as the emergency department, interventional radiology suite, or endovascular operating room.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to the emergency department with acute ischemic stroke symptoms within the therapeutic window for endovascular thrombectomy. The patient arrives by ambulance and undergoes rapid triage, stroke scale assessment, emergent non-contrast head CT (and CT angiography as indicated), intravenous access, and stabilization. Imaging confirms a large vessel occlusion amenable to mechanical thrombectomy. Door-to-puncture time is tracked from arrival to arterial puncture for endovascular access. Code G9582 documents situations where door-to-puncture time exceeded 90 minutes with no documented reason for delay. Typical site of service is an acute hospital inpatient or emergency department with an interventional neuroradiology or endovascular suite. A realistic scenario: a 68-year-old with right-sided weakness and aphasia arrives at 08:05, CT completed at 08:25, CTA at 08:34, transfer to angiography suite delayed by bed turnover and staffing, arterial puncture occurs at 09:40 — door-to-puncture >90 minutes with no documented justification, appropriate for reporting G9582 per quality reporting frameworks.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased Procedural Services | Use when work required is substantially greater than typically required and well documented (e.g., unusually complex thrombectomy). |